Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization.
Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation by a geriatric assessment team, (2) consultation by a "second opinion" internist, and (3) only traditional health maintenance organization services (control patients). The geriatric assessment team identified previously unrecognized problems in 35% of patients and advised changes in medication regimens for more than 40%. Nevertheless, patients who received assessment achieved only a small benefit in cognitive function after 3 months, which was not sustained for 1 year. There was no difference among groups in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.
Epstein
A M
AM
Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
Hall
J A
JA
Fretwell
M
M
Feldstein
M
M
DeCiantis
M L
ML
Tognetti
J
J
Cutler
C
C
Constantine
M
M
Besdine
R
R
Rowe
J
J
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration*; D003258:Consumer Behavior / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D015577:Geriatric Assessment; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D007388:Internal Medicine; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011897:Random Allocation; D012017:Referral and Consultation; D012237:Rhode Island